Case 116: Neuropathic Ulcer, Stasis Ulcer and Ischemic Hand Benefited by Boot

This man has had poorly controlled diabetes since 1962. He gained 85 pounds in middle age and developed recurrent problems with stasis disease and phlebitis. He was admitted to Bryn Mawr Hospital on January 31st, 1986 at age 54 with two painful feet, a stasis ulcer of the left leg and a history of multiple operations on his metatarsal heads. He had not responded to the treatments of his orthopod, podiatrist and internist. Position, vibration and light touch sensations were absent. The Q-tip of his culturette probe entered about one inch through a plantar ulcer into his right foot. His protein "S" level was found to be low normal perhaps explaining his familial tendency to recurrent phlebitis. As shown, below his feet did well with local antibiotics injections into the plantar ulcer, his boot therapy and intravenous antibiotics. He was discharged February 17th essentially healed..

Stasis pigment and a stasis ulcer under his malleolus are seen on the left leg. The plantar ulcer is under his right 2nd-3rd metatarsal heads.

The first right and all of the left metatarsal heads were surgically removed in the

Follow-up office booster treatment: his lesions are gone and his skin color is much improved.

He was followed for intermittent outpatient boot therapy with few problems until March of 1989 when he presented with hand pain. He had an ecchymotic spot on the right 3rd finger with diminished PPG flow in the end of the finger. Doppler studies showed reduced flow in ulnar artery, in the ulnar side of the palmar arch and in the 3rd finger.

The discoloration and his discomfort disappeared after boot therapy of his right arm.

He continued his regular visits to his podiatrist who subsequently admitted him to remove the other metatarsal heads in his right foot and consulted other specialties for multiple admissions to the hospital occasioned by recurrent foot ulcers and cellulitis. He has been lost to boot follow-up.

Comments: We have many physicians and allied services in our area who compete for foot patients.